=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356705164
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LOUY AL ATTEELI
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2016
-----------------------------------------------------
Last Update Date | 09/17/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10503 W THUNDERBIRD BLVD STE 101B
-----------------------------------------------------
City | SUN CITY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85351-2719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-974-3555
-----------------------------------------------------
Fax | 623-875-0777
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3502 W CAMELBACK RD
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85019-2707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | S021151
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------